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DEMO-15-2675 eIN Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)758-8972 Inspection Number. INSP-246130 Permit Number. DEMO-10-15-2675 Scheduled Inspection Date: February 02,2018 Permit Type: Demolition Inspector: Diaz,Osvaldo Inspection Type: Final Owner: SUB LLC,SRP TRS Work Classification: Plumbing Job Address:78 NW 107 Street Miami Shores,FL 33188- Phone Number (954)871-1400 Parcel Number 1121380070070 Project: <NONE> Contractor: HOMESTEAD REPAIRS AND SERVICES INC Phone: (788)332-2549 Building Department Comments DEMO FOR BATH AND KITCHEN. 6niractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed a Re-Inspection ❑ Fee No Additlonal Inspections can be scheduled until m-inspection fee is paid February 01,2016 For Inspections please call:(305)782-4949 Page 2 of 32 EMO-10-15-2675 Miami Shores Village PelritJf?jrpeFfllttlotr fr 10050 N.E.2nd Avenue NW � 0 W0*C6I5'6etj�Pl t1 Miami Shores,FL 33138-0000 ytie � ��►s:A !PRO ED Phone: (305)795-2204 �1 FLORIDA , t1t21120,1 Expiration: 04/18/2016 Project Address Parcel Number Applicant 78 NW 107 Street 1121360070070 Miami Shores, FL 33168- Block: Lot: SRP TRS SUB LLC Owner Information Address Phone Cell SRP TRS SUB LLC FL (954)671-1400 1999 harriosn Street oakland CA 94612- Contractor(s) Phone Cell Phone Valuation: $ 150.00 HOMESTEAD REPAIRS AND SERVICE(786)332-2549 Total Sq Feet: 0 Type of Demo:Plumbing Available Inspections: Additional Info:DEMO FOR BATH AND KITCHEN. Inspection Type: Classification:Residential Final Scanning:1 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 DBPR Fee $2.0o Invoice# DEMO-10-15-57493 DCA Fee $2.00 10/20/2015 Check#:6764 $50.00 $58.60 Education Surcharge $0.20 10/21/2015 Check#:6767 $58.60 $0.00 Permit Fee $100.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $108.60 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore.I authorize the above-named contractor to do the work stated. —544 October 21, 2015 Authorized Signature:Owner / Applicint / Contractor / Agent Date Building Department Copy October 21,2015 1 Miami Shores Village Building Department artment ` 0 2 0 2015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 I! INSPECTION LINE PHONE NUMBER:(30S)762-4949 � - FBC 20 t q _ BUILDING Master Permit No. )I5-• -2 2 PERMIT APPLICATION Sub Permit No. / S'- S ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ®RENEWAL [PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ®CANCELLATION ❑ SHOP r7 CONTRACTOR DRAWINGS }�7� JOB ADDRESS: °/d A)10 P / 2E' Aq4-�L� w4 Q',e S City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): Siz P 1 RS SL 1C- Phone#: ISG L ! - S�D- L Address:D-400 41 CAAPL� C-re-'rgk 10)1'A City:_ Ej k-w State: F2- Zip: X005 Tenant/Lessee Name: Phone#: Email: � CONTRACTOR:Company Name: D b h �.L�C Phone#: Address: 8430 X-A) I City -R�-fA State: f!AZip: x'31 SJ— Qualifier Name: C_ f C.-eZ PAD Phone#,: State Certification or Registration#: CFC- /f��Gj;—�-641 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#r Address: City: Staje: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: C> r)-r boj� k I C)n r Specify color of color thru tile: Submittal Fee$ Permit Fee CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ S?J ° 0 (ReWsedO2/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �e Signature Signature tR or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of / 20 I S .by day of _!/�- � .20 / by L. . {�nHall kno . .who i 0 1G/1!rte t�o I� v�?.✓��'`z.who is D�P`r�cersonally known to me or who has produced as me or who has produced identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC NOTARY PUBLIC Sign:. Sign: Print: Print: / ase Duay S•o� .os Seal: L4oa'L AON sai!dxd uolsslWWOO 41N=o& � Seal: 'ac COMMISSION f FF178270�Plaol�bo elel� ollQnd 6is3oN =�,°�,°a, EXPIRES:November 20,2018 t1131�l131S(1V 3NIatlPd �'�°,ati��` �� `�� WWW.AAROAINOTARY.COM APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦5 �I l7 .... n,e.l" Miami shores Village Building Department �ORIUA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS rVLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ............................................................................................ BUSINESS NAME: BUSINESS ADDRESS: 9(430 5w )-8 CITY—MSTATE V—ZIP 33kSs BUSINESS PHONE: 789 33X--1-5 IQ FAX NUMBER( ) CELL PHONE( ) QUALIFIER'S NAME: t c;t? C�a-1TA 4e Z QUALIFIER'S LIC NUMBER: MMM STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GONZALEZ,ELICIEL HOMESTEAD REPAIRS AND SERVICES INC 4606 HAZEL AVENUE SOUTH LEHIGH ACRES FL 33976 1 Professional Regulation. Our professionals and businesses range one Ffo►iaians lice( by the Department of Business and STATE from architects to yacht brokers,from boxers to barbeque restaurants T FLORIDA and they keep��'s Homy P OFE �REGULATIt REGULATION D . Every day we work to the way we do business in ordor to CFC1429298 serve you better. For inforrrmtian about our services please log onto wrorw.myfloridaffcerme ecm. There you Can find more trrfonnatiarr CERTIFIED PI), `GOttm"T R about our divisions and the that" YOU. t�ON7�LEZ,Et f to departmentnEnoWetters som more abort the D afirrenYs HOMESTEAD I2„ 1lIC S INC initiatives. �1 7F, Our mission at the Department is:License ERSciently,Regulate Fairly. " We constantly strive to serve you better so that you can serve your Customers. Thank you for fly business in Fronde, IS under ipe provtolons of Cn.4$9 FS. and owgrdtulations on your new license! +dat&-r+UG V.�; i(sass+ DETACH HERE - - RICK SCOTT;- ---- --- -- - - — -- _ - KEN LAWSON,SECRETARY STATE.OF FLORIDA DEPART T OF BUSIWESS AND PROFESSIONAL REGUL.A-nON CONSTRUCTION INDUSTRY LICENSING BOARD r CFC142929a The PLUMBING CONTRACTOR Narned below IS CERTIFIED Under the provisions of Chapter 480 FS. Expiration date. AUG 31,2016 p CiG}I�1ZAt.EZ�ELtCIEL 104 HL)ME$T -RIF'AIRS A�hS�tVICES INC � ; IMUM WOW015 DISPLAY AS REQUIRED BY LAW SEQLlMNIMD0495 aossio Local Business Tax Receipt Miami:-Dade County, State of Florida it -THIS IS NOTA BILI DO NOT PAY 6832571 %%LBT01 BUSINESS N"E[LOCATION RECEIPT NO. EXPIRES HOMESTEAD REPAMS AND SERULEESINC RENEWAL SEPTEMBER°30, 2016 8430 SW 28 ST 71062166 Must be displayed at place of business IVILM FL 33155 Pursuant to County Code Chapter BA-Art 9&10 OWNER SEC.TYPE OF BUSINESS' PAYMENT RECEIVED HOMESTEAD REPAIRS 8 SERVICES INC 213 SERVICE BUSINESS- BY TAX COLLECTOR Employee(s) 1 $75.00 07/09/2015 CHECK21-15-084667 Nat a Contractor Receipt This Local Business Tax Receipt only confirms payment of the Local Basinsss Tax.The Receipt is not a license, permit ore certification of the holdef'squalificatiorM to do bnsimess.Holdef east eompip lvith any goveramemal or nongovernmental regoletory lasts and requirements which apply to the business. The RECEIPT N0.above most be displayed on all commercial vehicles-Miami-Bade Code Sec Ba-Z7& For more Ldorms ion,visitww w.miamidade.govHaxcpJkechrr 1 ACERTIFICATE OF LIABILITY INSURANCE °"10=2015"' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOFAt1.1TICN O!1L"AVC C-ONFF.RS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE:Y PMENU,E)TEN[•OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES.MOT GOi46�ITJT E A CON;RA%;'BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL iMRED,the pollcy(lesi must be andorserL B SUBROGATION IS WAI .subject to the terms and conditions of the policy,certain policies m..y ret ulta an e.4orseme,t. A s ztenmat on this certificate does not confer rights to the certificate holder In Bunt of such endorsement(s). PRODUCER - +— —— ��'T Lucia Estrella Accurate P (305)226.8727 pfC p (305)226-8767 8300 West Flagler Suite 114 luclaestrella@bel souftnet Miami,FL 331" INSUREFQSI AFFORDING COVERAGE NAIL# Phone (305)226-8727 Fax (305)226-8767_____,igtM A: Granada Insurance CompBny INSURED INSURERS: Homestead Repair Service Inc INSURER C: 8430 SW 28th Street INSURER D: Miami FL 33155- NS E: URER F COVERAGES CERTIFICATE NUMBER: REVIS NUMBER: THIS IS TO CERTIFY THAT THE POI ICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SU84ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM 3 TYPE OF INSURANCE R I= POLICY NUMBER P F CY P LIMITS ® COA4MERCIAL GENERAL LIABILITY EACH CURRENCE S 1.000.ODO.00 ❑ CLAJMS-MADE ® OCCUR DPAMA SIOR ! D $ 100 ,000.00 A ❑ 0185FL0007226" 07/05/2015 07/05/2016 MED EXP(`ny ale person) $ 5,000.00 PERSO L&ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE L�IMpIT.APPLIES PER: GENERA AGGREGATE $ 1.000.000.00 ®POLICY ❑ pJECT C3LOC PRODUCTS-COMP(OPAGG S 1,000,000.00 ❑ OTHER S AUTOMOBILE LIABILITY D LIMIT $ ❑ ANY AUTO BODILY INJURY(Par Person) $ ❑ ALL AUTOS OWNED ❑ AUTOS BODILY BODILY"JURY(per acciderm $ ElNON-OWNED HIRED AUTOS ❑ AUTOS ( "On, � DAMAGE S ❑ ❑ S ❑ UMBRELLA L IAO ❑OCCUR EACH OCCURRENCE S ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ Mrl ❑ RETENTION $ PLCOMPENSATION ❑PEREMO ElOTH. YIN Aism ANY PROPRIETORIPARTNEWEXECII wfl EL.EACH ACCIDENT $ OFFICER/MWBEREXCLUDED? u NIA (Mandatory in NH) E.L.DISEASE-FA EMPLOYE 1$ I yes,describe wider DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT g DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddWonal Remarks Schedule,H more space is requhvd) License#CFC1429298 CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Miami Shores THE EXPIRATION DATEWNOTICE WILL BE DELiNERt�IN 10050 NE 2nd Ave ACCORDANCE WITH TH OVI ONS. Miami Shores,FL 33138 AUTHORIZED T:W Lucia Estrella 01 ORD CORPORATION. All rights reserved. ACORD 25(2014101)OF The A and largo are registered marks of ACORD I 06-22-2015 \a .� w �u av r°` JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 06/19/2015 EXPIRATION DATE: 06/18/2017 PERSON: GONZALEZ ELICIEL FEIN: 453551126 BUSINESS NAME AND ADDRESS: HOMESTEAD REPAIRS AND SERVICES INC 8430 SW 28 ST MIAMI FL 33155 SCOPES OF BUSINESS OR TRADE: 1- PLUMBING NDC AND DRIVERS 2- CERTIFIED PLUMBING CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 06114), F.S., an officer of a corporation poratfon who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05112), F.S., Certificates of election to be BxemPL.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Purbant to Chapter 440.05113), F.S., Notices of election to be exempt and ceniticates of election to be exempt shall be subject to revocation if, at any time after the filing at the notice or the issuance of the certificate. the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person'.'• named on the tertificate to meet the requirements of this section. QUESTIONS? (850) 413-161 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY O elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS!COMPENSATION LAW 0 D chapter. EFFECTIVE 06/19/2015 EXPIRATION DATE: 06/18/2017 H pursuant to Chapter 440.05112), F.S.y Certificates of election to be PERSON: ELICIEL GONZALEZ exempt.. apply only within the scope of the business or trade listed an FEIN: 452551128 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt HOMESTEAD REPAIRS AND SERVICES INC and certificates of election to be empt shall be subject to revocation 8430 SW 2e Sr if, at any time after the filing of notice or the issuance of the MIAML FL 33155 certificate, the person roamed on th notice or certificate no longer meets the requirements of this section fort issuance of a certificate. The department shall revoke a certificatBl at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named an the certificate to meet the requirements of this 1- PLUMBING NOC AND DRIVERS 2- CERTIFIED PLUMBING CONTRACTOR section. QUESTIONS? (850) 413-1609 CUT HERE * Carry bottom portion on the job, keep upper portion for you records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Homestead Repairs&Service Inc. 8430 SW 28 STREET MIAMI,FL 33155 TEL: 786-332-2549 Date: 10/14/15 State of )`C County of tD.Cf-P- Before me this day personally appeared C b c l el who,being duly sworn,deposes and says: That he or she will be the only person worldng on the project located at: Sworn to(or affirm d) and subscribed before me this day of1 0 20jL5by Personally Know Or Produced Identification Type of Identification Produced PJADINE AUSTERFIELD Print,Type or Stamp I#me of Notary Notary Public-State of Florida My Ccmr7lssion Expires Nov 7,2017 Commission S51 FF 58 . Contrac j ORE . . ... . • . 0:0•• V■.0 .. .. . . .. .. 5 1LiG 193a ` • loo o„lf ' ' "' ' ' ' ' "' Miami shores Village Building Department 000 600 goo 10050 N.E.2nd Avenue Miami Shores, Florida 33138 •• •• ••• •• Tel: (305) 795.2204 • ••• •• Fax: (305) 756.8972 .. . . . . . ... .. Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU OWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: .101 nr State of Florida County of Miami-Dade The foregoing was acknowledge before me this �' day of joOro bey ,20 1 :5. By Ca yY(J J>Aupll who is personally known to me or has produced as identification. Notary: CAtU&AlP SEAL: ,•�'�a�T14 Jose Chuay a c,. : = COMMISSION # FF178270 EXPIRES!Nember 20,2018 www.AARONNOTARY.COM